POS0057 WHICH ADVANCED TREATMENT SHOULD BE USED FOLLOWING THE FAILURE OF A FIRST-LINE ANTI-TNF IN PATIENTS WITH RHEUMATOID ARTHRITIS? 15 YEARS OF EVIDENCE FROM THE QUEBEC REGISTRY RHUMADATA™
Authors: D. Choquette, L. Bessette, L. Choquette Sauvageau, J. Brown, I. Ferdinand, P. Haraoui, M. Joly-Chevrier, A. Masetto, F. Massicotte, V. Nadon, J. P. Pelletier, J. P. Raynauld, D. Sauvageau, A. Turcotte, É. Villeneuve, L. Coupal
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Since 2000, advanced therapies (AT) have revolutionized rheumatoid arthritis (RA) treatment. Initially, TNF-targeted therapies were the only options. Then, therapies with different modes of action (OMA) appeared. Habits and medication availability often determine second-line AT choices. Research suggests that specific sequences provide better long-term effectiveness [1,2]. <h3>Objectives</h3> Evaluate which alternative medication provides the best sustainability following first-line TNF failure. <h3>Methods</h3> Data from AT prescribed since January 2007 was extracted from RHUMADATA™. Patients were followed until treatment discontinuation, loss to follow-up, or November 25, 2022. A descriptive statistic was used to compare patient characteristics. Kaplan-Meier was used to compare treatment discontinuation rates. <h3>Results</h3> A total of 611 patients (320 TNFi and 291 1237 OMA were included. The mean age at diagnosis was 44.5 (14.4) and 43.9 (14.8) in the TNFi and OMA groups, and disease duration at treatment initiation (TI) was 14.1 (11.1) and 12.9 (12.9). Women made up 72.8% and 81.1% of these groups. The age-adjusted Charlson Comorbidity index (ACCI) was 2.15 (1.7) and 2.1 (1.7). Patients reported more comorbidities, pain and fatigue, longer duration of morning stiffness, and higher HAQ score and disease activity in the OMA group (Table 1). The physician's global assessment of disease activity and the number of swollen and tender joints were also higher in the OMA group. OMAs retention was higher (Figure 1, logrank=0.0134) than TNFi retention following initial TNFi-IR. In a stratified analysis, rituximab (adjusted (Sidak) logrank=0.0048) had higher retention. <h3>Conclusion</h3> When a first TNFi fails, switching to an OMA, especially rituximab, appears to be the best strategy. Adequate assessment of more recent agents require longer observation periods. <h3>References</h3> [1]Choquette, D., Bessette, L., Alemao, E. <i>et al. Arthritis Res Ther</i><b>21</b>, 138 (2019). [2]Lopatina E, Marshall DA, Coupal L, Le Lorier J, Choquette D. Curr Med Res Opin. 2021 Jan;37(1):157-166. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Denis Choquette Speakers bureau: Abbvie, Amgen, Eli Lilly, Fresenius Kabi, Novartis, Pfizer, Sandoz, Tevepharm, Consultant of: Abbvie, Amgen, Eli Lilly, Fresenius Kabi, Novartis, Pfizer, Sandoz, Tevepharm, Grant/research support from: Abbvie, Amgen, Eli Lilly, Fresenius Kabi, Novartis, Pfizer, Sandoz, Tevepharm, Louis Bessette Speakers bureau: Abbvie, Amgen, BMS, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer, Sandoz, Tevepharm, UCB, Consultant of: Abbvie, Amgen, BMS, Celgene, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer, Sandoz, Sanofi-Genzyme, Tevepharm, UCB, Grant/research support from: Abbvie, Amgen, BMS, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Sandoz, Sanofi-Genzyme, UCB, Loïc Choquette Sauvageau: None declared, Jacques Brown Speakers bureau: Amgen, Janssen, Consultant of: Amgen, Gilead, Paladin, Pfizer, Ultragenyx, Isabelle Ferdinand Speakers bureau: Pfizer, Consultant of: Abbvie, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer, UCB, Paul Haraoui Speakers bureau: Pfizer, Consultant of: Abbvie, Amgen, Lilly, Pfizer, Sandoz, UCB, Grant/research support from: Abbvie, Amgen, Pfizer, UCB, Maxine Joly-Chevrier: None declared, Ariel Masetto Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, Consultant of: Abbvie, Janssen, Novartis, Pfizer, Sanofi-Genzyme, UCB, Grant/research support from: Novartis, Frédéric Massicotte Speakers bureau: Jansen, Consultant of: Abbvie, Eli Lilly, Janssen, Pfizer, Valerie Nadon Consultant of: Abbvie, Eli Lilly, Janssen, Pfizer, Roche, Sanofi-Genzyme, Jean-Pierre Pelletier Shareholder of: ArthroLab Inc., Consultant of: TRB Chemedica SA, Grant/research support from: TRB Chemedica SA, Jean-Pierre Raynauld Speakers bureau: Abbvie, Amgen, BMS, Eli Lilly, Janssen, Novartis, Pfizer, Sandoz, Sanofi-Genzyme, Consultant of: Abbvie, ArthroLab Inc., Janssen, Pfizer, Sanofi-Genzyme, Diane Sauvageau: None declared, Angèle Turcotte: None declared, Édith Villeneuve Speakers bureau: Abbvie, BMS, Novartis, Pfizer, Consultant of: Abbvie, Amgen, Novartis, Pfizer, Louis Coupal: None declared.